City of Minnesota Lake

Primary specialty

AmbulanceTaxonomy code 341600000X

License

0163 Issued in MN

Legal business name

CITY OF MINNESOTA LAKE

Practice address

100 Lake Ave E
#01
Minnesota Lake, MN 56068-7511

Phone

(507) 462-3277

Fax

(507) 462-3438

NPI assigned

Feb 25, 2009

Last updated

Apr 22, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Radtke

Title

Director

Phone

(507) 381-7696

Specialties & licenses 1

Addresses

Other names 1

• Minnesota Lake Ambulance Service Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1710127139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 MAIN ST. N",
            "address_2": "PO BOX 98",
            "city": "MINNESOTA LAKE",
            "state": "MN",
            "postal_code": "560680098",
            "telephone_number": "507-462-3277",
            "fax_number": "507-462-3438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LAKE AVE E",
            "address_2": "#01",
            "city": "MINNESOTA LAKE",
            "state": "MN",
            "postal_code": "560687511",
            "telephone_number": "507-462-3277",
            "fax_number": "507-462-3438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF MINNESOTA LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-25",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-14",
        "status": "A",
        "authorized_official_last_name": "RADTKE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "507-381-7696"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "MN",
            "license": "0163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Minnesota Lake Ambulance Service",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brandon Janike
• Stephanie Kruger
• Alison Montag, ATC, ATR, ITAT
• Cathi Ann Schirmer, OTR

• Ambulance in Minnesota Lake, MN
• Providers in Minnesota Lake, MN by specialty
• Ambulance in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.